What do you do if your new client is not only pregnant, but has never really been an “exerciser?”
This can be a challenging situation for a fitness professional, especially if you are new to training pregnant women. You will likely find conflicting information on what your client should and should not be doing, and it can be hard to know where to start, so let’s start with with basics.
First of all, we think it is brilliant that your new client has come to you for advice during this special time. Pregnancy can be an incredible opportunity for many women to start on a journey towards healthy living (that may extend well beyond the pregnant period).
The fact that your client has reached out to you for coaching is important, as we know that statistically very few women (around 15 percent) actually meet the recommended guidelines for exercise in pregnancy. There can be many barriers to exercise in pregnancy including factors like fatigue, family and work demands, musculoskeletal pain or lack of motivation.1 If she has made the effort to reach out to you, you will want to do your best to support her through this special time.
In years past, women were given advice from health professionals such as “don’t start any new form of exercise during pregnancy”, which eventually got watered down to “don’t start anything new in the first trimester.” Women were often scared to exercise and health professionals were very conservative in their recommendations.
Here’s the thing: for women with no contraindications, the benefits of exercise in pregnancy are so substantial that they far outweigh the risks.
Doctors now agree that in an uncomplicated pregnancy, all women should be encouraged to exercise regularly — even if they haven’t done much exercise before. Some of the benefits of exercise in pregnancy to mother and baby include:1-7
Improved (or maintained) cardiovascular fitness.
Improved maternal glucose tolerance.
Reduced risk of excessive weight gain.
Improved quality of life scores.
Potentially improved sleep quality and reduced insomnia.
Reduced lower limb edema and low back pain (exercise in water).
Improved psychological well-being (reduced rates of anxiety and depression).
Better self-esteem and body image satisfaction.
Decreased resting heart rate of the fetus and improvement of viability of the placenta.
Potential reduction in risk of preeclampsia.
Lower birth weight of baby, increased gestational age and potentially improved neurodevelopment.
Leaner body mass at age 5 for the infant.
So now that you know just how amazing exercise is for pregnant women, the next step is to find out if your client is safe to exercise. This requires screening by a medical practitioner (typically the obstetrician or GP), who will check to make sure your client does not have any medical or obstetric reasons why exercise might be problematic for her or the baby.
You can find a list of contraindications and relative contraindications in the recent Canadian guidelines for physical activity in pregnancy.10 Your client’s medical practitioner can also advise her on any precautions that she should undertake when exercising through her pregnancy.
What About Miscarriage?
It is important to understand that miscarriage rates have been reported to be as high as 12–15 percent, with most occurring in the first trimester.8,9 However, research has shown that exercise in the first trimester does not increase the risk of miscarriage.10
Although there is no link between exercise and miscarriage, it is worth finding out if your client has any fears around miscarriage, has experienced a previous miscarriage or has been undergoing IVF. In some of these circumstances, your client may prefer to commence her program in the second trimester — especially if she is new to exercise.
Once you have determined that your client is safe to begin exercise, it is important to find out:
What are her goals?
What has her previous experience with exercise been like?
What is her current level of fitness and skill?
What does she enjoy?
Let’s go through each of these questions individually.
1. What Are Her Goals?
Given that this client is not a regular exercise-goer, it seems prudent to find out why she is starting now. Is she concerned about her pelvic floor muscles? Does she want to have a healthy pregnancy so that she can offer her baby the best start in life? Is she concerned about putting on weight?
Your initial screening process will help you ascertain your client’s goals so that you can help her work towards them.
Your client’s goals for exercising in pregnancy may surprise you. If she states that her sister or mother had pelvic floor dysfunction and she is scared that she might have the same issues, it would be worthwhile referring her to a pelvic health physiotherapist for screening and advice. In the meantime you can use your sessions to help her gain better awareness of her breathing, posture and pelvic floor muscles.
If your client is scared about putting on too much weight during pregnancy, you can use your coaching skills to learn a little more about this mindset (we cover this in a lot more detail in the Coaching & Training Women Academy Pre- and Postnatal Coaching Certification).
Understanding your client’s motivation to begin exercising will give you a common ground in your work together.
2. What Has Her Previous Experience With Exercise Been Like?
This new client has does not have a regular habit of exercise — why is this the case? Is it because of she has lacked the motivation or time in the past? Does she hate the sensation of sweating? Do loud gyms give her the heebie-jeebies? Has she had bad experiences with fitness professionals in the past?
Finding out what her previous experience has been like and why she doesn’t participate regularly in exercise may help you avoid some of the same mistakes and get your client to develop a long-term love of exercise — or at least remove her distaste for it!
3. What Is Her Current Level of Fitness and Skill?
Where you start with this client will of course be very different if she a total beginner to strength training compared to if she was a college athlete but has taken a few months off more recently.
For women who are completely new to exercise (or have not done anything significant in recent years), it is recommended that you start with a reduced level of intensity and volume.
For example, the current guidelines for exercise in pregnancy are for women to do 150 minutes of moderate-intensity exercise (or 75 minutes of higher intensity exercise), plus two sessions of strength training per week. If your client has done nothing more than walking for 10 minutes per day, then you may start with walking 15 minutes per day over five sessions and then build up from there. You would start with a level of intensity where she can maintain a conversation (she should be able to talk, but not sing).
In terms of strength training, if your client has never lifted weights before, then you would use this opportunity to teach her the fundamental lifts with light weights and a focus on form. You should avoid more complex or high-skill exercises, where the risk of injury would be high.
For example, while low-skill exercises such as squats, deadlifts and bent-over rows might be a great place to start, high-skill exercises such as snatches and cleans should be avoided.
In terms of load, given her low starting point, you may well find that she increases the weight lifted over the course of the pregnancy, as compared to more experienced lifters who will usually reduce the weights as the pregnancy progresses. As always, this is going to be dependent on your client and her response to exercise. If your client has poor coordination and balance, start with exercises that use a wide base of support and fewer elements for her to control.
4. What Does She Enjoy?
Does your client like a structured exercise program, that is familiar and repetitive? Does she prefer variety and crave new exercises each week? Does she love that sensation of a burn in her thighs, or does she really love the “lengthening” sensation from yoga?
When it comes to exercise in pregnancy, there is no “perfect exercise” that suits everyone.
We have spoken to hundreds (if not thousands) of pregnant women and found that that many different forms of exercise have been enjoyed by pregnant women around the globe, including weight training, swimming, yoga, pilates, dancing, walking and so much more.
Find out what your client enjoys and what makes her feel good. Often, incorporating some mobility exercises into a program can not only be fun, but can help relieve aches and pains during pregnancy.
The Bottom Line
As you can see, the guidelines for exercising for “newbies” is very similar to what we would use for those who have exercised on a more regular basis. The main differences are that the starting point will usually be lower in intensity and volume and that the rate of progress through the exercises might be slower.
Be sure to monitor your client’s response to exercise to progress and regress appropriately, and be aware of the symptoms that will warrant ceasing exercise (such as bleeding, leaking amniotic fluid or chest pain) for any pregnant client.
As always, there are no recipes or strict rules, and as a good coach it is up to you to develop a good relationship with your client and monitor her through the pregnancy, adapting the exercises wherever required. Keep in mind that when working with pregnant or postnatal clients, exercises may need to be modified or changed frequently due to your client’s changing needs.
Prather H, Spitznagle T, Hunt D, Benefits of exercise during pregnancy, PM R. 2012 Nov;4(11):845-50; quiz 850. doi: 10.1016/j.pmrj.2012.07.012. https://www.ncbi.nlm.nih.gov/pubmed/23174548
Kramer MS, MacDonald SW, Aerobic exercise for women during pregnancy, Cochrane Database Syst Rev. 2006 Jul 19;(3):CD000180. https://www.ncbi.nlm.nih.gov/pubmed/16855953
Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R, Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial, Br J Sports Med. 2012 Jul;46(9):656-61. doi: 10.1136/bjsports-2011-090009. Epub 2011 Sep 26. https://www.ncbi.nlm.nih.gov/pubmed/21948120
Montoya Arizabaleta AV, Orozco Buitrago L, Aguilar de Plata AC, Mosquera Escudero M, Ramirez-Velez R, Aerobic exercise during pregnancy improves health-related quality of life: a randomised trial, J Physiother. 2010;56(4):253-8 https://www.ncbi.nlm.nih.gov/pubmed/21091415
Nascimento SL, Surita FG, Cecatti JG, Physical exercise during pregnancy: a systematic review, Curr Opin Obstet Gynecol. 2012 Dec;24(6):387-94. doi: 10.1097/GCO.0b013e328359f131. https://www.ncbi.nlm.nih.gov/pubmed/23014142
Kasawara KT, do Nascimento SL, Costa ML, Surita FG, e Silva JL, Exercise and physical activity in the prevention of pre-eclampsia: systematic review, Acta Obstet Gynecol Scand. 2012 Oct;91(10):1147-57. doi: 10.1111/j.1600-0412.2012.01483.x. Epub 2012 Jul 24. https://www.ncbi.nlm.nih.gov/pubmed/22708966
Hollenbach D, Broker R, Herlehy S, Stuber K, Non-pharmacological interventions for sleep quality and insomnia during pregnancy: A systematic review, J Can Chiropr Assoc. 2013 Sep;57(3):260-70. https://www.ncbi.nlm.nih.gov/pubmed/23997252
Maconochie N, Doyle P, Prior S, Simmons R, Risk factors for first trimester miscarriage-results from a UK-population-based case-control study, BJOG, https://doi.org/10.1111/j.1471-0528.2006.01193.x
Lashen H, Fear K, Sturdee DW, Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case–control study, Human Reproduction, Volume 19, Issue 7, 1 July 2004, Pages 1644–1646, https://doi.org/10.1093/humrep/deh277
Mottola MF, et al., 2019 Canadian guideline for physical activity throughout pregnancy, Br J Sports Med. 2018 Nov;52(21):1339-1346. doi: 10.1136/bjsports-2018-100056. https://www.ncbi.nlm.nih.gov/pubmed/30337460
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